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(Kitty is working on overcoming agoraphobia and writes from time to time about her process. Here’s some sound advice about setbacks.)

How regress can be progress

I had some setbacks recently, lots of very high anxiety days and a lot of panic attacks. It’s easy to get disheartened by stuff like this. It’s easy to wonder why you should bother. But you must not think that way. Setbacks and relapses happen to everyone recovering from something. They are always temporary and much easier to bounce back from than the original problem. If you’re climbing a tree to get away from a bear and you fall back one branch, do you jump down from the tree and let the bear eat you? No. You keep climbing. It was just one branch and you’re still farther from the bear than you were when you started. So if you fall in your recovery, keep climbing.

In my experience, when you have a relapse it’s best not to dwell on thoughts like, “But I was doing so well.” You’re still doing well. It’s not your fault the anxiety is stronger this week. You didn’t do anything wrong in your exposure. Keep doing your exposure during a relapse too. It’s harder but it will prevent the agoraphobia from becoming more malignant again. The best thing to do is ride it out. It will end – probably in a week or two. In my experience, relapses never last longer than that. Just keep reminding yourself that it’s temporary. Maybe do twice the meditation and/or mindfulness exercises that you usually do.

When your anxiety gets unusually high, it might not be best to jump to the benzo bottle as quickly as you normally would during a bad streak, because you would end up using it too often. One of the best ways to get rid of anxiety is to forget you’re having it. There are several ways that I go about doing this. As I mentioned in my intro post, sometimes I call a family member or a friend who I have really good conversations with and they will get me so involved in talking about another subject that I forget I’m anxious and it goes away.

Then there’s mindless television. I never pick a show I’m gonna connect with or have emotions about for this. I pick things like Bigfoot documentaries or World’s Wildest Police Chases. Reading is a good one, because that engages all of your brain. There’s no part left over to be anxious with. I’m partial to Sherlock Holmes stories.

The important thing to remember is that setbacks will happen, but they never have to mean a return to square one.

(Kate is a guest blogger from Canada who writes from time to time of her work on overcoming agoraphobia and its effect on her as wife, parent and businesswoman)

Season’s Change

This winter as many of you know, especially those of you living in the eastern half of North America, was colder and snowier than anything we have experienced in years.

Winter has always been a difficult time for me. The time change, temperature change, shorter days and lack of sun make me fall into SAD (Seasonal Affective Disorder) very easily. But worse for me is the lack of mobility.

This winter has been one of the worst I can remember and when I look at my agenda compared to last year’s agenda I am down about 75% “going out” ability. I rely heavily on my bicycle to either ride or balance my walking, to get me out of the prison of my house. I drive very little in the winter. I will take it out of the driveway a couple of times during the week and drive a few blocks but that’s about it. I do it only for the purpose of getting in the car and driving – not to get anywhere.

I live in a bike friendly city but this past February the snow and cold kept coming and never thawed and I was only able to manage going out for dinner once. At least it was once and better than not at all! But the snow mounds act as a claustrophobic barrier and the ice encrusted roads are not overly bike tire friendly. So, I have felt particularly trapped this winter as many of us have. I am full of shame and guilt that I can’t just get in my car and drive down to Florida for a break or hop on a plane for that matter.

One of the trickiest parts of the transitions of seasons for me has been the “start-go-stop” cycle. Now that it’s spring, I will be enthusiastic about the thaw and the budding crocuses. I will drive more, be with friends more, attend functions more and do regular day to day things more. It’s an awakening I look forward to each year. However, I will be good for a few months until the oppressive heat and humidity of July and August hammers down and drives me back indoors to the air conditioned comfort of my living room until September when I resume my going out activities until January when I shut down completely and just want to hibernate until spring.

This “start-go-stop” cycle drives me batty because I can go and go, achieving real headway in my recovery process during the fair-weather months and then the change in season kidnaps me and keeps me hostage until the weather changes. It feels like learning how to walk all over again every few months.

I have wondered what it would be like to live in a more temperate climate like Hal mentioned in his book Un-Agoraphobic. There are very few options for moving within Canada where you don’t have to experience winter. Next year in January, I will sign up for an online university course or two to keep me motivated throughout the winter and as an assurance that I will be far too busy to be spending the winter in Florida.

I have more than once pretended to be happy about something or another in order to please or at least placate someone else, but it turns out I could also fool myself by faking it.

Brain scientists have shown that focusing on and repeating any thought, action or behavior stimulates the brain into creating new neural pathways in order to facilitate that process. It makes sense to me; it’s sort of like you start lifting weights and after awhile it gets easier because your muscles get bigger and more efficient.

If you suffer from panic disorder you have evidence close at hand proving the brain will pay attention to whatever you want to focus on at that particular time. You have subconsciously and consciously informed your central nervous system that you are in some sort of danger, so the system gears up to be ready whenever the “danger” occurs. That’s why you’re nervous. You are tense and tight and hyper-vigilant because your amygdala thinks something bad is going to happen without warning.

Your high level of anxiety of course makes it much more likely you’ll be startled or stimulated which will trigger a flood of adrenaline that creates the extreme feeling of terror we call a “panic attack.” The bad thing happening is happening because you programmed yourself to be on the look out for fear. It’s not something you were necessarily doing on purpose, but because the feeling of being in danger (from a panic attack) creates new thought pathways, pretty soon you’re stuck with being a nervous wreck.

Luckily, your brain will do pretty much anything you want it to, even feeling calm and at ease. You can totally reverse your current situation though the response may be slow in coming. There’s lots to undo and redo, but you can do it. I set up a daily work program in my book, Un-Agoraphobic to accomplish that very thing – to set the brain in motion with positive thoughts and and activities. Creating new neural pathways that relate to safety and comfort and happiness is what will help you recover from panic disorder and agoraphobia. To start it off, all you have to do is smile, as you’ll learn in the following article.

I like to occasionally refresh memories and acquaint newcomers of just what it is we are talking about when we refer to panic disorder and agoraphobia. I’ll give my quick definitions and then go over the basic brain science that tells you why you have what you have and how you can get out of it.

My definition of panic disorder is the general state of anxiousness that results from having had one too many panic attacks. Agoraphobia describes the avoidance one employs to feel safe. After only one PA, your amygdala starts to work against you in a bizarre and not at all helpful way. The guard at the gate for your brain is where all data enters your sensory ports (5 in the norm). That most primitive part of the central nervous system must begin the sorting process for everything that happens to you – each sound, each new image in your eye, each word spoken, read or thought, each thing touched, etc.

Traffic is dispatched to various parts of the brain as amygdala and its memory-making compatriot hippocampus make the crucial choices that make you behave the way you behave by reacting the way you react to any given stimuli.

The amygdala process is nearly instantaneous. If cave dwelling you were out on the savannah gathering nuts and berries and saw a human-eating beast of some sort, you would be in full sprint just like that. Stimulus=Response=Survival (or not). Your amygdala would have shouted (by sending adrenaline) to all systems and when the amygdala shouts, your systems listen because they could die if they didn’t. You are now essentially a primitive beast with momentary power, speed, strength and will to do things you could not ordinarily do. There are witnessed, documented incidences of ordinary people lifting cars off people while in full adrenaline fury.

That’s what’s happening to you when you have a panic attack. You are scared to death. Period. After you have a panic attack your amygdala undergoes neural activity to increase its capability to detect future danger. That activity is what we call “anxiety.” Gray matter builds in the area providing more and more guards to spread the word if that dangerous thing happens again. This is like military preparedness, where a country (you) sends armies by the thousands to a certain area to protect against threats. Everybody’s pacing about and anxiously perseverating about the enemy. Only there’s no enemy.

I was age 10 when something I don’t recall startled me one night, sending me into my first horrible panic flight. The unexplained and unexplainable incident left me feeling anxious most of the time for probably six months or so. That was the effect of my amygdala having gone into high alert. My high alert state was, unfortunately, making it more likely I’d have another panic attack.

I had another attack cycle at age 12, again at age 14 and 16, and just after my 19th birthday had a panic attack that made me agoraphobic for the next 30 years. I returned to being fearless a few months after each of the childhood panic cycles, but the one at 19, while on a road trip, was the final straw. I yielded to the power of my muscular amygdala and from then on had to be close to whatever constituted “safety.”

The word “irony” seems almost lame to describe what is happening to a person with panic disorder. Your amygdala thinks that your panic attack was a grizzly bear attacking you and is now “protecting” you by putting all systems on alert for another one of those…those…. Let’s let Amygdala explain away what it was that caused your most recent panic attack: “It must have been a huge bear of some kind because I was really really scared and opened the flood gates. The heart was beating like a jack hammer and the lungs were going in and out like a bellows and all the muscles were pumped up and the brain was whirling with activity. Gosh it was exciting! Did anyone see where the bear went?”

Here’s where you take your first step in your recovery from panic disorder and agoraphobia. You grab the amygdala around the throat and scream, “It wasn’t a Bear you Idiot! It was nothing!! You terrified me for NOTHING!!

After you let the amygdala know that you know what’s up, you can begin in my book Un-Agoraphobic the daily activities, studies and practices that will create new neural pathways working for you instead of against you. After a period of time of regular and vigorous work sessions as laid out in my recovery program, you will achieve a state of mind that makes it seems like you’re in a safe place. The amygdala can now walk the perimeters of your awareness and announce, “The place seems pretty secure. I don’t see any bears, so I guess I can start laying off some guards.

When I was on the hunt for something, anything, to clear up the mystery of my panic attacks and near constant anxiety, what I was actually seeking was wisdom.

Since I didn’t know what I was looking for, it took me a long time to find it. The survival tactics learned during 30 years with agoraphobia were part of my path toward wisdom. I was becoming a wise person in certain ways; I was learning enough to be able to make the right decision and take the right course because of my variety of experiences in a certain area. For example, I tried nearly every kind of therapeutic med until I gained enough wisdom to realize there isn’t a med to cure panic disorder.

I finally used all the wisdom I gained over the years from shrinks and therapists, psychiatric wards, many kinds of medication including alcohol, homelessness and despair, failed jobs and relationships, to understand the big picture regarding my agoraphobia. Of course I knew – every agoraphobe knows – that a panic attack presents no real danger, but fear is a stubborn bitch that won’t let go easily.

What finally led to my passage into freedom was the profound realization that I was my own center, my own safety net, that I was all I needed to rely on for a feeling of safety. I had gained enough wisdom to understand that there was no “place” of safety other than what was in my brain. When I comprehended that “safety” lay within me rather than outside of me, as in my apartment, I achieved a level of wisdom that set me up for my spontaneous trip away from home… away from the prison of agoraphobia.

You are gaining knowledge in your struggle to overcome panic disorder that will eventually make you wise enough to be free forever from your own prison. What you are trying to achieve is the understanding that you are taking your safety zone with you wherever you go. That is knowledge leading to wisdom that will free you.

Here’s an article about knowledge and the transit to pure wisdom by fellow Psychology Today blogger Jeremy Sherman that set me to thinking about my continuing journey. I hope this read is helpful to you as it was to me.

(Gene is a fellow agoraphobe who will be reporting in from time to time on his long struggle and his recent successes)

Going Far With the Right Connections

Rack up another victory in the travel log! (FWIW I keep a journal of my trips for several reasons: it’s a tangible record of my successes, thoughts and feelings; it inspires me to keep up the momentum of my exposure therapy; and it serves to remind me, when I get discouraged, that I am making progress, however fitfully, towards freedom from unfounded fear.)

To continue . . . am back home from my latest “road work” today and thought I’d share a few insights on the subject of connection in the hope you find them helpful in your own journeys.

I can distinguish between three kinds of connection in this regard. (BTW now I know why Hal stresses “connection, connection, connection is so important” in his book! The first kind of connection has to do with staying connected to your physical surroundings while you’re traveling. Why is this critical–and potentially even curative? Because observing and studying your surroundings in an objective way, taking in and enjoying or at least experiencing the passing scenery and your place in it, greatly helps to ground you (literally!) in the here and now. And why is this important? Well, for one thing, for me the feeling of being dangerously “way out here” arises from the belief I’m disconnected from my source of perceived safety “back there.” Thus my mind, courtesy of the Amygdala & Co. outfit in my brain, wants to fixate on getting me back home, back to the comfy Land of the Familiar. Replacing or eclipsing that location with the current view in front of me–be it persons or places of interest–helps to anchor me in objective reality while at the same time disconnecting me from the unreality (that is, the delusion) inherent in aggie. In other words, paying attention to my suroundings turns my mind towards what is really real, as opposed to what only FEELS real–that crazy aggie fear.

The second kind of connection, intimately related to the first kind, is staying connected in a time sense. It is practicing being wholly present in the holy present. More and more I find it’s an effective antidote to the “what-if” bug that spawns so much of the futurizing and attendant catastrophizing that plagues us agoraphobes. “What is happening right now?” “Am I alive and breathing and functioning OK right now?” “Right now, am I in danger or just in discomfort?” “Am I remembering to recite my affirmations to myself, stay loose, stay distracted, and breathe properly in time to defuse any mounting anxiety or at least ride out a panic attack?” I think these are the kind of questions that we need to ask ourselves and keep asking ourselves every so often as we’re traveling.

The third kind of connection I can see is connection to one’s self. Each victory increases my self-confidence, which increases my self-esteem, which further increases my self-confidence . . . in a virtuous circle. The more self-confidence I exhibit in my willingness and ability to do the work of recovery (via exposure therapy) the better I feel about myself and the stronger and freer I become. And the closer I get to uncovering the real me, the person presently “behind bars,” so to speak, imprisoned by fear. For me this person is–or has been–a frustrated world traveler and explorer. An intelligent risk-taker, a curious discoverer, a confident adventurer. It’s the me who growls, “My brain got me into this mess in the first place (for whatever reasons of self-protection) and it can just as well get me out of it!” Amen to that.

So connection to the environment we’re in or traveling through, connection to the here and now, and connection to our real self are some of the “right connections” that can help us to move forward in our quest to live an aggie-free life.

(This is the first of what I hope will be many guest blogs from folks engaged in overcoming agoraphobia)

Have Turtle, Will Travel

First off, I’d like to thank Hal for inviting me to be a guest blogger on this site. It’s an honor and a priviledge and I’ll try to uphold his confidence in me. From time to time I will be sharing personal thoughts and experiences on my road to putting aggie behind me. Maybe, like Hal, but in my own small way, I can help others on the same journey to lasting freedom and a shiny new life.

This first post of mine is entitled “Have Turtle Will Travel.” I call it that because I recently installed a toy bobble-head turtle (actually it’s a “tortoise”) on the rear deck of my car to help remind me that I take my home with me wherever I go, and therefore I can feel safe no matter how far away I am from my physical home. Whenever “distance anxiety”– what I called aggie before I knew its clinical name–rears it’s ominous head, I repeat to myself “I am as safe here as I am in my own living room, because I am my own home.” It’s one of the prized affirmations in my mobile toolbox. In short, the Kingdom of Home is within me.

There may be a way for you to see a panic attack coming from some distance away and be able to get out of the way before it runs you over in the usual freight train fashion.

I came across a study done at Southern Methodist University that indicates people who suffer panic attacks have some physiological symptoms nearly an hour before the dreaded event. Most people who have panic attacks will tell you they come on suddenly, without warning. But after reading this study I recall that I had vague symptoms before many of my panic attacks, but didn’t know what to do about them. I probably didn’t recognize the indicators for what they meant.

It’s been more than 20 years since I suffered a panic attack, but I recall that I often experienced tightness in my jaw leading up to yet another series of panic attacks. The study continuously monitored panic disorder patients employing heart rates, respiration and skin conductive responses. Researchers noted marked changes in these areas for panic attack victims, noting the changes were similar to those experienced by people about to experience a stroke, seizure or even manic episodes.

One notable change in people leading up to a panic attack was in breathing: monitors noted decreased and shallower breathing with increased levels of carbon dioxide. High levels of carbon dioxide are associated with panic attacks, according to the study.

I’ve posted a link to the article on the Medscape website. Read it and try to recall experiences you may have had with “aura” like feelings or bodily changes preceding a panic attack. Now that I know that my tightened jaw and shallow breathing were symptoms of an upcoming attack, I’m certain I could have taken steps to avoid an attack. Next time you’re experiencing some pre-panic symptoms, begin daily regimens of deep breathing and positive imaging to turn the panic monster away.

If everything could just kind of jingle this time of year, folks with panic disorder might be okay with all the increases in stimulation. The problem is there’s way more jangling – nerve jangling – than the sweet little jingling we prefer. As a result, this is a time of great suffering for many people with chronic panic attacks.

When your nerves are already jangled with ever-present anxiety, the holiday season can easily put you over the top. I recall my most anxious times during my years with agoraphobia were from T-Day to New Year’s. Now I understand that my environment of supposedly cheery, festive occasions was loading up my fight or flight system. The colored lights, the crowds, the noise, the blurs of activity, were just increased stimulus as far as my amygdala was concerned.

If the same cycle occurs for you, I’d be interested to hear about it. Send an email if your panic attacks get much worse during the “holidays” and you want to hide from it all. I was nearly homebound on at least two of the Christmas/Thanksgiving periods. I recall feeling deep despair this time of year. Agoraphobes know they will most likely face demands to travel during the holidays, so their nerves get amped up by that threat.

You are expected to get things for people; online shopping makes life easier, but there are some things you’ll have to go out for. My increased anxiety level was probably also due to the contrasts between how everyone around me was apparently feeling – kind of happy and pepped up and bustling around – and the way I was feeling, which was desperately unhappy and frightened. I remember more than one holiday season when I felt that I could just no longer go on… I mean go on. I did, and so shall you my friend.

What I needed during periods of heightened anxiety was something to focus on; something I could start doing that would demand all my attention and take my fears away. I didn’t have much to turn to in earlier years, but once I discovered art and clay I had something to go to and begin creating. When you enter the creative process your fears will nearly or completely disappear. When you live fully focused on the present moment of creation, the past and future are just that.

My advice to you is to start making things for people. Make by hand every present you’ll give this year and enjoy the satisfaction of creation and the delight of discovery from the receiver. Your gifts could range from found and modified art to drawings/paintings/collage, to poems or stories or songs you write. Cookies! Your gift can be homely or lovely, but I guarantee that in the eye of the receiver your gift will be beautiful. You may discover a talent you weren’t aware of and begin pursuing whatever way you decided to make your own presents.

Schedule some daily breathing timeouts throughout the coming weeks and try to sit in meditation at least once a day. This would be a good time to transfer your extra stimulation to your journal. Make a holiday observation every day- remarking on particularly gaudy or tasteful things you saw or heard in passing, for example. Writing will help you focus on recovery.

Be extra mindful of everything around you this year. By focusing on one thing at a time you’ll greatly reduce your anxiety level. Study colored lights closely. Look at people’s faces and clothing with increased interest. Listen intently to each sound you hear and try to isolate it. Doing things of this nature will I hope make the task of being in holiday crowds easier for you.

Social isolation can be a serious matter for homebound agoraphobes this time of year. Reach out to others in whatever way you can – from writing nice letters to phone calls to visits. Stay connected with your world throughout the holiday time. Bake delicious things and invite people over. Give yourself the present of a comfortable holiday season for a change.

I’d like to de-mystify agoraphobia a bit by discussing the various manifestations of classic panic disorder. I think most civilians equate agoraphobia with hiding in the house, but that’s not true all the time or even at all for everyone who suffers from this mental illness. My personal experience as well as what I learned from mental health clients and peer support group members led me to rate agoraphobia by severity:

– Level 1. Housebound or mostly so.

– Level 2. Partially mobile.

– Level 3. Mobile with a wall.

Many people who suffer panic attacks when they venture beyond their safe perimeter have experienced all three levels at one time or another. I ran the gamut more than once during my 30 years with agoraphobia. The housebound stage is usually the result of extra stressors; the increase in fear level that drives someone into a corner is demoralizing. Being inside can feel safe, although terror-stricken people will resort to hiding in small spaces to reduce the fear level. A great day for someone at Level 1 is a trip all the way to the end of the block. The victim’s fight or flight system is on such a high stage of self-imposed alertness that unending anxiety is the result. Someone at this high level of anxiety feels that a panic attack is so nearby that one dare not rock the boat.

When agoraphobes are at Level 2 they are able to work and go to school, though with great difficulty. Going to and from is likely the most difficult of every day’s difficult tasks. Those periods of vulnerability bring out an agoraphobe’s talent for catastrophic thinking. Anything and everything can be a threat, but bridges, railroad crossings and long lines of streetlights are particularly troublesome for someone at this anxiety level. Work may be the easiest part of the day; a job that requires total focus on the work is good for the agoraphobe who wants to shut out anxious thoughts.

Many people with long-term agoraphobia spent a lot of time at Level 1. I did. When you are able to work and have relationships and feel free from heavy anxiety, you can become complacent. Eventually, though, being stuck at this level is heartbreaking because you are so near yet so far from complete freedom. You’re still a prisoner even if you have a good job and relationships.

So… the truth is out: No one is safe from agoraphobes because not all of them are locked up in their houses. Some of them are moving about you, working with you, touching you, and even…. Yes! Agoraphobes can appear to be nearly normal, if not more so.

Start increasing your functioning level by decreasing your fear level with the help of “Un-agoraphobic.”

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Unagoraphobic.com – is the one web site and blog dedicated solely to recovery from panic disorder and agoraphobia and we want you to think of this as your home. This is a safe place where you can read and write comments as well as ask questions and get answers about agoraphobia. Millions of people around the world from all levels in society suffer from this condition. Now there’s a structured program designed to heal the whole you and free you from your prison. I created the agoraphobia Recovery Program based on my experiences as a long time sufferer (30 years), as a mental health social worker and as a writer. I look forward to hearing from you as you begin your journey.